Our last week at Kenya

We just concluded our 3-week on-site project at AAR and are very happy with the work we delivered and with the positive feedback from management and staff. On Tuesday we gave our final presentation to AAR’s management and to staff from Human Resources and AAR’s Group Care. Our presentation focused on the methodology we used to create the process manuals, the best practices we learned during our project at AAR, and the benefits of documenting processes. We thought this would be the best way to pass on our knowledge and experience to an internal ARR group that can capitalize on our work and continue the task of documenting all processes across AAR. We also showed the product of our 3 week project, 25 manuals for the Team Leader, Medical Assessor, Claims Assessor and Membership leader positions.

During our presentation, we devoted a significant portion of the time for Q&A and enticed participants to voice what they thought could be the benefits and the challenges in carrying ahead our project. The discussion was lively as the Human Resources members present were very interested in understanding the details of our work and wanted to know our opinion on what we thought could be the best way to complete the manual documentation task for the rest of the Kenya operation and then to the other AAR companies in East Africa. To respond to this, we emphasized the need of appointing a full time team to accomplish this task rather than assigning it in addition to their daily tasks. We also stressed the importance of following the framework/methodology we documented in the presentation, and in particular of performing the different testing rounds we recommended to ensure that all documented processes are 100% accurate.

We had a great time in Kenya and were gladly impressed by the kindness of everyone we crossed paths with. Our farewell from AAR was emotional, and it was sad to say goodbye to all the new friendships we made. It was also sad to say goodbye to Mrs. Beckmann and to her house staff, who took care of us during our stay. We hope to stay in touch with the people we met with and to come back to Kenya in the near future! Ashante sana AAR!

Last week was very productive and full of new and enlightening experiences. We continue to enjoy our stay at AAR and we are greatly impressed by everyone’s hospitality. We met Mrs. Beckmann, one of AAR’s founders and our host. Conversations with her have been inspirational, as she continues to provide part of the vision for the company.

On the process manuals elaboration front, we have achieved great progress. We are almost done drafting, testing and re-testing all of the job positions in the claims department. The process has been very interesting, as it has allowed us to deeply understand one of the most important processes at the core of the insurance division. It has also provided us with insight on potential areas for improvement that we will share with the management team when presenting our work. We are currently working on the Document Processing processes, and will start focusing on the Membership department later this week.

We also made a lot of progress with our analysis of different business models for health delivery to the lower income segment of the population. We met with Mr. Steve Maina from AAR and also visited two great organizations: Carolina for Kibera and Jamii Bora. Mr. Maina, currently is leading an internal strategic effort at AAR to develop a product to target this segment. From our conversation with Mr. Maina, we learned that AAR is very keen in serving this segment of the population and is currently working on establishing a health insurance and delivery pilot project.

On Wednesday, we visited Carolina for Kibera and met the team headed by Mr. George Kogolla. We learned about their business model, which aims to improve living and health conditions for residents of Kibera, Nairobi’s largest slum, through initiatives that focus on sports, health education, leadership training and trash management. In partnership with the Central for Disease Control (CDC), Carolina for Kibera also operates a clinic – “Tabitha” – which is located in the slum. We visited the clinic after walking for 20 minutes into the poor community, where the contrast between the deficient sanitary conditions and the smiles of the little kids playing on the streets was astonishing. The clinic, a three story building that emerges within houses made of carton and metal, provides primary care for around 300 individuals a day. The facilities house multiple consultation rooms as well as modern lab testing equipment for early disease detection. The clinic is currently awaiting for an X-Ray machine that will expand the services offered to the community. Health services are provided for free for those residents inscribed in the CDC’s surveillance program (which currently includes two communities in Kibera), and for a very affordable fee for other newcomers. Through its programs, Carolina for Kibera is having transformational impact on the community by empowering its individuals, improving their health conditions, and showing them that despite poverty there is future away from violence and drugs.

On Thursday we visited Jamii Bora, another great organization that focuses on micro-credit and which leads several programs that aim to improve living conditions for the poor of Kenya. Jamii Bora began as an organization focused on providing assistance for street mothers in the form of loans, the goal was to help provide healthy living, as its name translates in English. Through an organized savings program sponsored by a Swedish woman who had adopted a street boy and learned about the crude reality lived on the streets of Nairobi, street mothers started accessing opportunities they never dreamt of in life. The organization started with 50 women who saved KES 10 each week and then lent the money to each other, allowing them to start their own businesses and care for their children. The organization grew rapidly, and quickly evolved into a micro-credit institution that provides loans for the poor, using as collateral the savings accumulated under its flagship savings program. Sadly, in 2001 the HIV/AIDS epidemic was harshly on a rise in Kenya, and borrowers started defaulting on their loans. Jamii Bora’s dedicated team began to visit those defaulted borrowers and came to understand that the borrowers were using the funds to pay for hospitals and health related issues rather than to pay for their owed interest. This spurred the creation of an inpatient health insurance product provided at low cost (KES 1,200 or US$ 17 annually) to all of their depositors and financed through a loan – similar to the standard micro-credit loan – with required payments of KES 30 (US$ 0.42) per week. This has allowed their borrowers to have operations that they thought would never be possible for them due to their high costs. Currently, Jamii Bora has around 300,000 members, who access micro-credit loans, health insurance, and other services like housing and education based on the organization’s savings scheme. A truly transformational organization!

On a separate note, we could not miss visiting the incredible Masai Mara, and did a weekend safari where we experienced unbelievable moments seeing “game” animals in their habitat. Check out a few pictures!

Our First Week at AAR

We have already started our field project at AAR in Nairobi, and so far have completed 3 days of work during which we have accomplished significant work. We were warmly received by an enthusiastic team of people, who have put all existing resources available to us to make our experience a very rewarding and productive one. Mr. Francois van der Merwe and Mr. Edward Rukwaro are our supervisors and have been very supportive in helping us establish rapport with the staff, especially those with whom we will be interacting with to make our project successful. They have also made sure that we our comfortable and that we can efficiently perform our job in the organization.

On our first day at work last Wednesday, Mr. van der Merwe and Mr. Rukwaro made an introductory presentation of how AAR is organized. We also spoke about the project, the specific deliverables and agreed on the steps to better implement our main goal: the elaboration of process manuals for the claims and membership processes (which are the most critical processes of the insurance and medical services offered by AAR). We are well underway in the elaboration of all the manuals for the staff in the Claims Department. To accomplish this, we have interviewed team leaders, medical assessors and claim assessors to learn about their jobs and the different steps and activities they perform as a base for our documentation. We hope that by mid this week, we can proceed to document the processes in the Membership Department.

We are also very excited about our visit to Carolina for Kibera next Wednesday January 13. We will meet and interview Mr. George Kogolla, who runs the program, and look forward to learning about their business and health delivery model. We will keep you posted.

Our Home in Nairobi

On our way to Nairobi

In preparing for our arrival to Nairobi, we had a very interesting conversation with Brett Bullington, who put us in touch with Carolina for Kibera (www.carolinaforkibera.org), which we plan to visit once we are in Nairobi. Mr. Bullington is a member of the Board of Directors of Carolina for Kibera, a non-profit organization in Nairobi founded by a University of North Carolina student in 2001. The organization is located in Kibera, one of Nairobi’s slums and its primary mission is “to promote youth leadership and ethnic and gender cooperation in Kibera through sports, young women's empowerment, and community development.” In addition, the organization provides other services such as healthcare, with its Tabitha Clinic, sanitation and is expanding into education. The organization has been quite successful and has served as a model for other grassroots organizations in Kenya and in other countries in Africa, therefore we are sure that it will be quite a learning experience for us and for AAR. We are specifically interested in learning about the model of Kabitha Clinic, which Brett mentioned was serving the whole Kibera community and had just recently expanded its services. We are also currently in the process of contacting other organizations that we think we will be very interesting to visit so we will keep you posted.

We are very excited to report that the four of us are now in the African continent: we are in Cape Town, South Africa. We have been amazed by the beauty of the scenery; having on one side the superb Table Mountain, and on the other, a spectacular coastline that boarders charming historical towns. We have also been embraced by South Africa’s friendly and welcoming hospitality which has quickly made us feel “at home.” We have visited the Cape of Good Hope, seen the penguins at Simon’s Town, fed ostriches, gone up Table Mountain, and look forward to visiting the wine country and swimming with the sharks in the coming days. Cape Town is truly the “Mother City” as the South Africans call it.

Preparing for AAR

Approved work plan

We finally got our work plan approved and are very excited to start our journey with AAR in Kenya! AAR is the largest and most successful private health care company in East Africa. It operates in Kenya, Rwanda, Tanzania and Uganda, providing preventative and curative health care to clients as well as recue and evacuation services. They have approached MIT Sloan so that we can help them address two critical areas:

• Codify knowledge via process documentation
• Evaluate potential services AAR can provide to the bottom of the pyramid, as well as share best practices of their for-profit model to other organizations in Kenya.

We can’t wait to get on the ground!

Getting ready

We are currently preparing ourselves while we are in Cambridge for our visit to Kenya. Our preparation includes several fronts: learning about Kenya and the healthcare industry, talking to experts about process documentation, researching documentation frameworks and getting in touch with local organizations. And of course, purchasing our tickets, which we already did, so we are getting closer to being ready for AAR and Kenya!

• Talking to experts: In the past few weeks, we have approached several experts who have been very helpful in sharing their insights and expertise in process documentation, medical processes and in recommending others who we should speak to.

o MIT Sloan Faculty: We have talked to professors in the Operations department to get their insights about process documentation. We have also approached the Organizational Processes faculty to make sure we have the right strategy when approaching the AAR staff. We want the staff to talk with us as freely as possible, so it is important for us to have a clear strategy. Finally, we have also gotten to know professors that are experts in Kenya like professor Suri from the Economics department. We are starting our contact with her to get the lay of the land on Kenya.

o MIT Medical: Has been a great source of information since they perform a similar role as AAR. The Human Resources director, Winnie Dansby, has been extremely helpful and has shared with us two manuals on MIT Medical’s processes that will be very helpful as we come up with our own framework for the manuals.

o MIT extended faculty: We attended the recitation on “Networking and Connecting with domain and country experts” and met Jose F. Gomez-Marquez, the program director of Innovations in International Health. He has been very helpful in putting us in touch with colleagues in Nicaragua and Pakistan who are working in successful health-delivery models.

o AAR team: We have also spoken with Steve Mania from AAR who has worked with the bottom of the pyramid at AAR. He is helping us set-up meetings with organizations in Nairobi that we can visit and interview.

• Research: We have actively used the library resources at MIT Sloan (i.e. the librarians) to guide us through the different databases we have access to. Thanks to them we already have useful information that will help us create the framework for the manuals:

o Insurance procedures manuals

o Claims handling best practices

• Last year’s team: We reached out to last year’s G-Lab team who has been very helpful in sharing their positive experience with AAR with us. Their insights have been great and have shared tips for our trip and our project. We will definitely continue to be in touch with them as our project progresses.

Overall, we feel we are on track. Our workplan is approved, after some minor roadblocks, our research is moving along and we feel more familiar with our project. We are getting ready to submit our Interim Report which will be very useful for our final deliverable.

We have 2 more weeks of school to go to finalize our ground work and get ready for the real thing…. We’ll keep you posted. The next post will be closer to our departure for Nairobi.